Post-It Note to Myself

You are feeling good! You can get to this place again!

So says the third post-it on my bathroom mirror. Both my psychiatrist and my therapist insisted I do something to remember this time. “Most people don’t remember their good times. They forget and think it has always been this bad.”

My first post-it says, “Bipolar is just one part of me.” I don’t believe that right now, but I used to believe it and maybe I will again. The second post-it says, “You are brave and courageous.” I believe that one finally, even after a couple friends have spent years telling me that. These post-its are signposts of health I want to follow. I added a third one only because it is so important.

I have changed so much in the last 10 months since my move to Texas. Healthier, mood stabilized (for now), happy, motivated, energized. I feel I have to put that caveat in there since, as my therapist said, moods change. I can be honest that I will fluctuate. And my psychiatrist expects narrower swings. So the future might be closer to a healthy person’s mood changes. I have to tell myself it might be possible to have a positive future.

My therapist reminded me that it’s not just the 23 ECT treatments that brought me here. I worked hard for this. I learned and practiced dozens of coping skills. I’ve been through dozens of medication changes. Each of my 40-something hospitalizations has led to increased health and stability. I have spent years in weekly therapy, and I have bared my soul to multiple psychiatrists. I cultivated caring and dedicated support systems. I could go on.

The two sentences on my post-it contain all I have written here. This blog post will be one I return to, I hope.

No ECT!!!

I showed up for my scheduled ECT this morning. And in the pre-screen I talked about how well I’m doing, back to baseline on everything. Somehow the conversation twisted and the PA asked if I even wanted a treatment today. Um, NO!

I waited an agonizing 5+ minutes while she talked with the treating psychiatrist. They agreed I was doing well enough not to have a treatment! I’m to call in a week for a phone screen to see if I’m still doing well or if I need a treatment. If I’m doing fine, they will discharge me and I can get the port out of my chest (used to access a vein easily since IV’s are hard to get on me).

Hooray! I celebrated my unexpected free day and good prognosis with a ginormous mocha from the coffee shop in the hospital lobby.

I also saw my regular psychiatrist today to ask about the fine tremors I have developed in my hands. But, I got to gloat about how well I was feeling. And I was shocked to be doing so well that he wanted to see me next In Three Months(!).

Even as I’m feeling well, and stable, and Good, I’m worried about the bottom falling out and plunging into suicidal depression for the millionth time. My doctor encouraged me not to worry about what might happen, and even to make a video or add to my mirror post-its that Yes, I was doing well. Something to help remember if (when?) things get bad, that I had been healthy and it would happen again.

Why do I expect suicidal depression to come again? Just because it has been a companion I could count on? And I got as good as one could get at dealing with it healthily?

How about I have no freaking clue how to be in a good space? I’m worried that the increased energy I feel is mania, and that the only way I have to express how good I’m feeling is to talk too much or to spend money. Both of those are things I do when I’m manic, yet I’m not manic.

I just don’t know how to be healthy! What are behaviors You have when You are healthy?

See! You Have a Purpose

So I was talking to my therapist, as one does, and we were exploring what to do with the ever-present suicidal thoughts. He had tried getting me to welcome them as just part of the landscape of my mind, something I’m pretty good at doing already. Most of the time I Accept that they are there, and recognize that they are just thoughts. At various and sundry times, intent to follow through on the thoughts accompanies the thoughts, adding fear and a third dimension to what had just been landscape. Then suicidal suggestions become action instigators, and I worry, fret, ruminate and finally find someone to talk to about the thoughts until they become landscape once again.

Even as mere landscape, suicidal thoughts are not at all pleasant. Just live-through-able. I don’t want them. Now, at least. Sometimes I want them and I want to act on them. But 97% of the time, I want them gone.

So I accept their presence, in good ACT fashion (Acceptance and Commitment Therapy). The next step, says Wise Therapist, is teaching them some boundaries. In a kind but firm way, order them away. As a small child I was often sent to my room to play, when the parents needed a break. So too, I must send the suicidal thoughts to their room when I need a break. Give myself some breathing room.

Now, we uncovered today that the undercurrent of the suicidal thoughts is the thought that I don’t have a purpose or goals. I have that thought a lot on its own, and it shows up again, subtly, with the suicidal thoughts. I hadn’t noticed it there before! I think if I send the thoughts to their room, then I need other thoughts to think about: my purpose in life and small and large goals. But I don’t have those, I protest!

And I change the subject, to my brother’s very recent colon cancer diagnosis and upcoming surgery (read more here: http://gofundme.com/markfightscoloncancer). Wise Therapist puts together that the same week I struggle with my Christmas Delusion and then persistent and pervasive suicidal thoughts, I manage not to go to pieces over my brother’s diagnosis and am the only family member to keep it together.

See! You do have a purpose! exclaims Wise Therapist. You didn’t set yourself and emotional needs aside, nor did the family situation exacerbate your symptoms so that you freaked out.

I think being steady through a volatile time for my family was the purpose he was getting at. I’m not sure I agree, but it did seem I was holding it together for people. I still don’t have goals or a larger purpose – in my mind – save for doing something interesting every day and surviving, or persisting as my bumper sticker says.

Is that all I need right now? Can I persist with no goals, no hopes, no plans. No real purpose, even for my upcoming trip to Chicago. Is persisting enough?

Around the Cycle Goes

This week has been up and down and around as my mood, or more my thoughts, cycle through various mental phases.

I started the week with the ever popular Xmas delusion I get every year. Fortunately it lasted only several hours on Xmas Eve when I was in and out of touch with reality. My mood was still in the middle but dipping at times on Xmas Eve and Xmas Day.

Then December 26th, I was back! Mood perky and happy and optimistic. Mere fleeting thoughts of suicide (baseline for me to just have a few).

And then on the 27th, OCD thoughts kicked in and all I could tell myself was plans to kill me. All the time. And again I couldn’t talk about it or tell anyone until my NAMI support group meeting that night. Then I could articulate calling the ECT office to see if getting ECT earlier than scheduled might help. And I could note that I really needed to tell my mom about the OCD suicidal thoughts. And I was encouraged to contact my therapist, who did tell me to contact the ECT office and let them decide if I needed one.

You see, my mood was great! Stable, and in the middle. Not depressed. Not hypomanic. I just had obsessive, albeit dangerous, thoughts. I didn’t know if I would get to a point of having intent though.

When I called the ECT office today, the 28th, I thought the thoughts were less obsessive and therefore farther away from any intent. But later in the day they were just as obsessive and I worry about intent showing up. Or if obsession will finally give way to compulsion in OCD. It never has for me, but will there come a day that the pathology progresses?

My mood is still stable, happy, good, in the middle. It’s just my thoughts. I don’t want to kill myself, I just can’t stop holding it out as a possibility. Obsession. I suppose if I was worried enough, it would warrant a hospitalization. But, again, my mood is great! It’s just the obsessive thoughts.

Sigh.

I hate mental illness.

The Hardest Part of the Year

I’m trying not to over-anticipate the next 10 days. Right now my bipolar is stable and in the middle. (Yay!!) But there’s a full moon, a solstice and a Christmas delusion which all have strong possibilities of messing up my mood, sending me into delicious mania with hallucinations and delusions, or into fateful suicidal depression with plans and intent. Either pole is equally likely.

And full moons, solstices and equinoxes can all mess up my mood pretty good. There’s a moon event and a sun event on this coming weekend, right about the time my Christmas delusion likes to come into play with false beliefs about who I am and what my purpose in life is.

So how do I prepare for a messed up mood, yet take each moment as it comes and let these next 10 days be just another 10 days? I don’t even know how to ask for help for this!!! I feel if I just take each hour, each minute as it comes, and a mood disturbance/episode happens – And I Haven’t Prepared Myself For It – I could fall pretty far off the deep end and it could take months to recover. And to prepare for a mood disturbance/episode feels like walking on eggshells so that at least I’m not blindsided. I don’t know how else to prepare. Help!

Taking a Look Around

I did not go to the hospital for ECT this morning, for all the reasons given in yesterday’s post. I just don’t think the presence of suicidal thoughts that are part of my mind’s landscape on a normal day – given the lack of intent and concrete plans – warrants an ECT treatment. I’m not ruminating on suicide as I do when the pathology is present.

Today I’m taking a look around the landscape of my thoughts and feelings in this new and dazzling place of “somewhere in the middle.” What does it look like to have a sad thought but not be depressed??? I don’t know! But I had one today. What is it like to feel content and happy but not be euphoric and taking risks??? I don’t know! Yet I would use those words to describe my mood today: content, happy.

What else is going on in this mood state? I popped out of bed rather quickly this morning. I’m being more kind and helpful than ordinarily with grocery shopping and cooking and chores around the house. I made extra coffee just because instead of thinking I had no energy for extra anything.

I’m noticing that I have negative self-talk about myself and that I don’t believe the negative things any more. How weird is that? A coping skill since diagnosis over 8 years ago has been positive self-talk and changing negative self-images and thoughts to positive ones. I have found this skill elusive most of the time. I just don’t believe the positive stuff. But today! Today and this week so far, I have only positive things to tell myself. Even when I notice something negative, I’m quick to do a reality check and change what I’m telling myself. What is this new persona, that I tell myself positive things about my image and personality and worth as a human?

Suicidal Perspective

No, I’m not suicidal. At least I don’t think I am. I am scheduled for a 21st ECT tomorrow, but am authorized to call it off and schedule for Thursday instead if I don’t have any symptoms. Which means I’d be down to once a week – and I’d be allowed to drive again. So am I suicidal? Am I paranoid? Am I depressed?

The doctors think the irrational fear manifesting as paranoia is part of the cognitive side effects of ECT. So the presence of some paranoia is not cause for having a treatment tomorrow. I don’t think I’m depressed either; I have been highly motivated to do things and be social this weekend, and my mood is elevated. I don’t believe we’re in hypomania territory either.

Finally there is the ever-present suicidal ideation. They are just thoughts that pop into my head and are easily dismissed, even plans or the occasional desire for death. I’m not ruminating on death or desiring it as I think about it. The desire and intent to follow through just isn’t present. So, yes, I’m having suicidal thoughts – as is usual for me – but I’m not depressed, and the plan(s) are only theoretical, not action plans.

In fact I’m re-reading Night Falls Fast by Kay Redfield Jamison, about understanding suicide. This read through I’m not looking for ideas or plans or reassurance – or even a reason Not to kill myself. I don’t have a suicidal perspective. My mind is approaching the topic as a curiosity: why would someone think such thoughts or consider such actions? What psychopathology do I manifest when I’m thinking of suicide or taking actions toward it? And while I look with curiosity, thoughts of suicide do pop in and out and I wonder if I am thinking too seriously of suicide and need an ECT treatment tomorrow. My mind’s perspective is not suicidal though, even though I have energy and drive to follow through on plans. I don’t desire death. And, in fact, I wish to desire life. So sometimes I do desire life, and sometimes I wish I did in the midst of suicidal thoughts popping in and out.

But I don’t think I need a treatment tomorrow!